Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection



Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection, but the management of recurrent HCC remains unclear. To compare the efficacy and safety of radiofrequency ablation (RFA) and repeat resection as the first-line treatment in recurrent HCC.


This multicenter retrospective study analyzed 290 patients who underwent RFA (n = 199) or repeat resection (n = 91) between January 2006 and December 2016 for locally recurrent HCC (≤ 5 cm) following primary resection. We compared the overall survival (OS), progression-free survival (PFS), and complications between the two treatment groups for the total cohort and the propensity score matched (PSM) cohort.


The 1-, 3-, and 5-year OS (90.7%, 69.04%, 55.6% vs. 87.7%, 62.9%, 38.1%, p = 0.11) and PFS (56.5%, 27.9%, 14.6% vs. 50.2%, 21.9%, 19.2%, p = 0.80) were similar in the RFA group and the repeat resection group. However, RFA was superior to repeat resection in complication rate and hospital stay (p ≤ 0.001). We observed similar findings in the PSM cohort of 48 pairs of patients and when OS and PFS were measured from the time of the primary resection. The OS of the RFA group was significantly better than repeat resection group among those with 2 or 3 recurrent tumor nodules in both the total cohort (p = 0.009) and the PSM cohort (p = 0.018).


RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications. RFA is more efficient and safer than repeat resection in patients with 2 or 3 recurrent tumor nodules.

Key Points

• Recurrence rate is up to 70% at 5 years for hepatocellular carcinoma (HCC) after initial resection.

• RFA has the same efficacy as repeat resection in recurrent HCC patients, but with fewer complications.

• RFA may be preferred for those with 2 or 3 recurrent HCC nodules.

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Alanine aminotransferase


Confidence interval


Hepatocellular carcinoma


Hazard ratio


Model for end-stage liver disease


Magnetic resonance imaging


Overall survival


Progression-free survival


Propensity score matching


Radiofrequency ablation


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The authors would like to thank Prof. Ying Zhang (Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States) for the revision of the draft.


This work was supported in part by the National Natural Science Foundation of China (No. 81570551; 81770607) and Key Research Project of Shandong Province (No. 2016GSF201008).

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Corresponding author

Correspondence to Qiang Zhu.

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The scientific guarantor of this publication is Prof. Qiang Zhu.

Conflict of interest

Dr. Mindie H. Nguyen has received research support from the National Cancer Institute, B.K. Kee Foundation, Gilead, Pfizer, and has served as consultant and/or advisory board member for Exact Sciences, Laboratory of Advanced Medicine, Gilead, Eisai, Bayer, Spring Bank, and Novartis.

All other authors hereby declare that there is no potential or actual personal, financial, or political interest related to this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

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• multicenter study

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Feng, Y., Wu, H., Huang, D.Q. et al. Radiofrequency ablation versus repeat resection for recurrent hepatocellular carcinoma (≤ 5 cm) after initial curative resection. Eur Radiol (2020).

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  • Hepatocellular carcinoma
  • Radiofrequency ablation
  • Hepatectomy
  • Treatment outcome